Transcranial Doppler: a noninvasive method to monitor hydrocephalus

The ability to discriminate between ventriculomegaly and hydrocephalus often relies on clinical impression and parameters such as change in ventricular size and configuration, increasing head circumference, and evidence of developmental delay. In an effort to confirm clinical impressions, 24 children underwent transcranial doppler (TCD). All had ventriculomegaly confirmed by computerized cranial tomography (CT), magnetic resonance imaging (MRI), and/or cranial ultrasound (CS). Fifteen were infants and nine were older children with closed fontanelles. Three patient groups were established. Group 1 included those patients with ventriculomegaly but no clinical evidence of increased intracranial pressure. Group 2 included those children with hydrocephalus and evidence of increased intracranial pressure. The last group consisted of hydrocephalic children who had shunts placed for increased pressure. The Gosling pulsatility index (PI) as well as the peak systolic velocity (PS) as measured by the TCD were compared in all three groups. The PI was found to be a useful indicator of increased intracranial pressure and need for eventual shunt. Transcranial doppler sonography may therefore prove useful as a noninvasive, easily reproducible screening tool to evaluate children with hydrocephalus.